How to get in on the wheel deal

Staff Q&A: David Fox

Eating late night

While discussing a patient early in his career with colleagues, Albert Stunkard played a tape recording of her describing her many struggles.

What his colleagues heard was a startling tale of incest and psychological damage. One of the doctors listening, overcome by the story, actually bolted from the room.

But when Stunkard later tracked his colleague down, he found it wasn’t the incest that had spooked her—it was the patient’s descriptions of her battles with obesity. Stunkard’s colleague, like the patient on the tape, had also struggled with her weight—and shared a tendency for enjoying meals in the middle of the night.

“That really stuck in my head,” says Stunkard, an emeritus professor in Penn’s Department of Psychiatry.

The conversation turned out to be a career-changing event for Stunkard. In the years that followed, he would research obesity ever more closely, eventually zeroing in on a disorder that he himself described, for the very first time, as Night Eating Syndrome. The year was 1955, and Stunkard was on the cutting edge of eating-disorder research. “There was really not much study of eating disorders at the time,” Stunkard says. “Nobody was really interested in them.”

Stunkard was. A half-century later, in fact, Night Eating Syndrome remains his focus.

Last year, Stunkard helped lead a Penn-sponsored study on the syndrome with three other Penn researchers, and used the results as fodder for his latest book, “Overcoming Night Eating Syndrome: A Step-by-Step Guide to Breaking the Cycle,” which he co-authored with Kelly C. Allison, a clinical psychiatrist and director of Penn’s Night Eating Study.

“We’ve really made enormous progress,” Stunkard says. “I think Night Eating Syndrome is, today, better understood than any of the other eating disorders.”

At the root of the syndrome, Stunkard believes, are skewed biological patterns. People with NES wake up without an appetite. By nighttime, they are ravenously hungry, and eat their largest meal late in the day. They then suffer through a restless night of sleep—Stunkard says a typical NES patient gets only two-thirds the sleep an average person would—and when they awake, they eat, even in the middle of the night, and even if they’re not actually hungry.

“A lot of them will say they’re not hungry,” Stunkard said. “What they will say is that they feel they have to eat. What I think is happening is that some of these people started suffering from insomnia, and then they found eating helps them get back to sleep.”

Stunkard says recent research suggests NES has a genetic basis, but he also says NES will very often only become apparent in times of stress. Additionally, many NES patients—about two-thirds in the Penn study—are depressed.

It’s that link to depression, Stunkard says, that has led doctors to an unlikely treatment. He said the anti-depression drug Zoloft has shown great promise. So far, Stunkard says, Zoloft has helped two-thirds of the Penn NES patients achieve full remission. Half of the remaining patients have at least shown improvement.

And while Zoloft often takes two months to ease depression, it has helped NES patients in as little as two weeks. That quick turnaround, Stunkard says, suggests the drug is working in some unusual way; it’s not attacking the depression, necessarily, but helping ease NES symptoms through some other avenue.

“It’s working by some other kind of mechanism,” Stunkard said. “Nobody is quite sure what that is yet.”